Governments all over the world are still counting the cost of more than two years of restrictions caused by the Covid pandemic, both in economic and societal terms. Among the key issues that many countries are addressing is the disruption to healthcare systems throughout this period, not least the reduction in the detection and diagnosis of cancer. A sharp fall in the number of face-to-face appointments at hospitals and doctors’ surgeries during Covid lockdown periods had a dramatic
effect on screening programmes and diagnostic testing.
As a result of the pauses in screening, the referral of new cancer cases saw a marked decline, as Professor Chris Nutting, consultant in clinical oncology at The Royal Marsden NHS Foundation Trust and clinical director of The Royal Marsden Private Care at Cavendish Square in central London explains: “A major hospital, such as The Royal Marsden, takes in tens of thousands of cancer patients a year at a fairly constant rate. However, after the first UK lockdown started in March 2020, the referral rate dropped considerably.”
Professor Nutting is also concerned about potential patients who may have cancer symptoms that have not been correctly assessed. “I think there is a specific subset of patients with cancer symptoms that resemble those of Covid – for example, those with lung cancer. Their common symptoms are coughing and breathlessness, which could quite easily be mistaken for Covid.
“Some of the people with these symptoms will have had undiagnosed lung cancers that were not detected as quickly as they should have been. Such delays in diagnosis are a major concern for cancer specialists.”
So, what can a patient expect when they are referred by their doctor to a specialist cancer centre, such as The Royal Marsden? “We offer a comprehensive cancer service, which caters for patients coming in at all stages of the journey,” says Professor Nutting. “When a patient is referred they will be examined by a specialist and may also have some tests, such as a biopsy of a lump, or a scan. Should the tests confirm a diagnosis of a cancer, then the patient’s case is discussed in what is called a multidisciplinary team, or MDT.” This process brings together all of those involved in a patient’s treatment – doctors, nurses, surgeons and specialists in chemotherapy and radiation – to formulate an individual treatment plan that is regularly reviewed by the team.
Early diagnosis of cancer presents an obvious advantage in tackling the disease, increasing the efficacy of treatment and boosting survival rates. Screening for breast and cervical cancer in women and prostate cancer in men are among the best-known procedures to identify any issues before symptoms appear. Early detection of other common cancers is also of interest to Professor Nutting and his colleagues. “One of the areas we’re particularly interested in is lung health, for patients who have been smokers in the past and are at risk of getting lung cancer, including those who gave up smoking as much as 10 years ago,” he says. “Too many patients present with lung cancer that is well advanced, perhaps even with disease that is no longer curable at that stage. Similarly, those with abnormal moles and lumps in the skin are also encouraged to come forward for testing, before any disease becomes too advanced.”
While many diseases and medical conditions can be diagnosed using a blood test, the most common cancers, including bowel and lung cancers, historically could not be detected in this way. Such diseases usually require scans or more invasive examinations in order to be diagnosed.
However, hope is on the horizon that such cancers can be detected by a blood test at an early stage, and treatment monitored in the same way, as Professor Nutting explains. “In the past few years it has been discovered that, if a patients’ cancer is slowly growing, it is releasing debris into the bloodstream, so there are new methods emerging to try and identify this genetic material – known as circulating tumour DNA (ctDNA) – in the blood.
“Obviously, cancer cells have a different genetic make-up to the patient’s own DNA. So, if this additional material disappears after the treatment, then you can be confident that it has been successful. This technique is already being used for treatment monitoring, but the hope is that the detection of ctDNA in the blood could also become a method of screening for a wide range of cancers, in a way that hasn’t been possible so far. That’s a very exciting potential advance for the future.”